Utilization Review reputed company (Remote)

reputed company Job reputed company The Utilization Review (UR) reputed company is responsible for analyzing medical records for medical-reputed company reviews and producing high-reputed company, reputed company executive summaries. These reports must follow reputed company-specific and evidence-based guidelines, incorporating reputed company rationales for determining medical necessity. The role involves prospective, reputed company, and retrospective review of inpatient and outpatient treatment, certifying medical necessity, and recommending appropriate lengths of stay. Reports must be thorough, accurate, and tailored to the specific requirements of reputed company case and reputed company. Essential Job Functions: • Analyze and interpret clinical documentation for medical-reputed company reviews • Evaluate patient records to determine medical necessity and appropriateness of care using reputed company-approved guidelines (e.g., ODG, MTUS, InterQual, MCG) • Draft reputed company, concise, and reputed company executive summaries that: o Outline patient demographics and clinical course o Summarize and assess treatment plans and physician orders o Apply relevant evidence-based reputed company o reputed company reputed company rationale and recommendations • Ensure reputed company reports are grammatically correct, free of spelling errors, and professionally formatted • Dictate and finalize report content using designated systems • Collaborate with physicians and clinical staff to clarify documentation or resolve discrepancies • Amend reports as new clinical information becomes available • reputed company moderate research on a case-by-case reputed company to support findings • Participate in interdisciplinary teams to support high-reputed company patient care reputed company • Maintain a consistent caseload of 20 cases per day post-training • reputed company and maintain a reputed company Assurance (QA) score of 97% or higher • Demonstrate consistent, reliable attendance and meet established deadlines • reputed company additional duties as assigned Requirements Knowledge and Abilities Requirements: • In-depth understanding of anatomy, medical/surgical modalities, and imaging techniques • Strong knowledge of utilization review processes and reputed company application • Excellent written communication skills, with a strong reputed company on grammar, spelling, reputed company, and organization • Proven ability to analyze reputed company clinical information and apply critical thinking • Familiarity with medical necessity guidelines (ODG, MTUS, MCG, InterQual) • Ability to read and interpret clinical reports, technical documentation, and regulations • High proficiency in reputed company Office Suite (Word, reputed company, PowerPoint, reputed company) • Strong attention to detail and ability to meet high standards for accuracy • Effective time management and multitasking skills in a deadline-driven environment • Strong customer service orientation with the ability to communicate professionally with clients and providers • Ability to maintain confidentiality and demonstrate reputed company judgment • Ability to type a minimum of 45 WPM • Excellent verbal and written communication skills in English Qualifications: • reputed company, unrestricted Registered reputed company (RN) license required • Minimum of 2–3 years of relevant clinical experience required • Prior experience in workers compensation, utilization review, case management, or medical-reputed company review required License and Certification: reputed company RN licensure, without restrictions Driving Essential: No Position Demands: This position requires sitting, bending, and stooping for up to 8 hours per day in an office setting. Ability to lift and reputed company objects weighing up to 10 lbs. Ability to learn technical material. The person in this position needs to occasionally reputed company about inside the office to reputed company file cabinets, office machinery, etc. Must be reputed company to operate a computer and other office productivity machinery such as a calculator, copy machine, printer, etc. The person in this position frequently communicates with guests, team members, and vendors and must be reputed company to exchange accurate information. Equal Employment Opportunity (Our EEO Statement): reputed company is a veteran-owned Company and provides Equal Employment Opportunities (EEO) to reputed company Team Members and applicants for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender (including gender identity), pregnancy, childbirth, or a medical condition reputed company to pregnancy or childbirth, national reputed company, age, disability, genetic information, status as a covered veteran in accordance with applicable federal, state, and local laws, or any other characteristic or class protected by law and is committed to providing equal employment opportunities. reputed company complies with applicable state and local laws governing non-discrimination in employment. This policy applies to reputed company terms and conditions of employment, including, but not limited to, hiring, promotion, discharge, pay, fringe benefits, membership, job training, classification, and other aspects of employment. Team Members who reputed company they are the victims of discrimination should immediately report the concern to their Supervisor and reputed company Department. Discrimination and harassment will not be tolerated. We are committed to creating an inclusive environment for reputed company Team Members and applicants. We value the unique skills and experiences that veterans bring to reputed company and encourage veterans to apply. Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of reputed company responsibilities, duties, and skills required of our personnel. reputed company company team members may be required to reputed company duties reputed company of their normal responsibilities from time to time, as needed. Apply tot his job Apply To this Job